P550: INFLUENCE OF RACE ON COMPLICATIONS OF INTENSIVE CHEMOTHERAPY IN AML
Authors: Ivy Abraham, Garth Rauscher, Anand Patel, Sarah Monick, Madelyn Burkart, Ami Dave, Vedavyas Gannamani, Amani Erra, Ahmed Aleem, Nepheli Raptis, Matthew Kroll, Maryam Zia, Stephanie Tsai, Melissa Larson, Wendy Stock, Jessica Altman, Irum Khan
Journal: HemaSphere (2023)

Background: A database analysis of over 40,000 AML patients found that 26% of patients who received induction chemotherapy were admitted to the intensive care unit (ICU), with increased mortality for non-white patients (Halpern. JAMA Oncology 2016). Moreover, in our earlier work (Abraham. Blood 2022), ICU admission following intensive induction was a significant mediator of Black-White survival disparities in AML patients. Aims: The current study compares pre-treatment comorbidities and the spectrum of early post-treatment complications and mortality across racial and ethnic groups using the Chicago AML registry patients that received intensive chemotherapy between 2012 and 2018. Methods: 573 patients who underwent intensive induction chemotherapy for newly diagnosed AML were compared across ethnoracial groups with respect to i)pre-treatment comorbidities and disease characteristics ii)rates of organ specific toxicity and detailed infectious complications, iii)duration of ICU stay and 90 – day mortality. Finally we conducted a multivariable analysis incorporating individual and neighborhood level social measures as well as clinical and molecular characteristics at diagnosis to identify predictors of ICU admission following intensive chemotherapy. Results: Non-Hispanic Black patients had significantly higher pretreatment creatinine and lower albumin. In terms of disease manifestations, NHB had significantly higher rates of severe anemia, lab evidence of DIC and higher ELN risk scores and prevalence of TP53 mutations. Baseline Charlson Comorbidity scores were significantly lower in Hispanics compared to other groups. Hyperleukocytosis and extramedullary disease rates were similar across groups. The spectrum of early treatment complications varied significantly based on race/ethnicity. Acute kidney injury was dramatically higher in NHB patients with an incidence of 27.8% with 7% initiating dialysis compared to 17.6% of NHW and 11.3% of Hispanic patients. Infectious complications were highest in NHB with microbiologically documented infections in 51% compared to 39% in NHW and 33% in Hispanic. Venous thrombosis rates were similar across groups In total, 181 patients required ICU admission during intensive induction with rates differing significantly by race and ethnicity. Average length of stay in the ICU was 7.8 days for NHB patients, 6.7 days for NHW and 6.0 days for Hispanics. Mechanical ventilation was utilized in 32% of NHB compared to 26% of NHW and 17% of Hispanic patients admitted to the ICU. Vasopressor requirements were similar. Factors associated with ICU admission (Table 1) included non-white race, insurance status, living in a predominantly NHB neighborhood, renal insufficiency, WBC>50K and coagulopathy at diagnosis. Multivariable analysis is ongoing. Importantly, 90-day mortality was significantly higher in NHB patients (10%) compared to NHW (2%) and Hispanic (5%) pts (p=0.001). Summary/Conclusion: In a diverse urban population of AML patients, baseline comorbidities and disease characteristics differed by race and ethnicity highlighting the need for validation of recently developed AML comorbidity indices in diverse populations. In addition, hypoalbuminemia, anemia, renal dysfunction, and DIC in NHB patients may indicate undiagnosed comorbidities and allostatic load contributing to higher rates of ICU admission and early mortality. Our work suggests the need for equity-focused clinical trials that take into account comprehensive measures of allostatic load guiding alternate dosing schedules or lower intensity therapies.Keywords: Race, Clinical outcome, Chemotherapy toxicity, Acute myeloid leukemia